5101:1-38-04 Medicaid: outstationing workers at disproportionate share hospitals and federally qualified health centers.

(A) This rule describes the administrative agency's role in facilitating outreach services for low-income pregnant women and children through the process of outstationing at disproportionate share hospitals and federally qualified health centers.

(B) Definitions

(1) "Administrative agency" is the county of job and family services, the Ohio department of job and family services, or other entity that determines eligibility for a medical assistance program.

(2) "Combined program application" (CPA) is a multiple program application that contains clearly identifiable medicaid-only sections or parts.

(3) An "individual" is:

(a) An applicant or recipient of a medical assistance program; and,

(b) For the purpose of this rule, a pregnant woman or child.

(4) "Initial processing" means taking applications, assisting applicants in completing the application, providing information and referrals, obtaining required documentation needed to complete processing of the application, assuring completeness of the information contained on the application and conducting any necessary interviews. Initial processing does not include evaluating the information on the application and supporting documentation, or making a determination of eligibility.

(5) "Outstationing" is the federal requirement that states provide low-income pregnant women and children opportunities to apply for medicaid, at locations other than the local county department of job and family services.

(C) Responsibilities of the outstationed worker.

(1) The outstationed worker must complete the initial processing of the CPA as defined in paragraph (B) of this rule. When authorized by the administrative agency, the outstationed worker may also determine medicaid eligibility.

(2) If the outstationed worker is only performing initial processing duties, the outstationed worker must forward the CPA to the administrative agency in accordance with Chapter 5101:1-38 of the Administrative Code.

(3) The outstationed worker must accept and refer applications for other public assistance programs to the administrative agency for processing.

(4) If the administrative agency determines that an outstation site is infrequently used and does not require a full-time outstationed worker, a notice must be displayed advising the following:

(a) The hours when an outstationed worker will be available; and

(b) The telephone number of the administrative agency that individuals may call for assistance.

(D) Responsibilities of the individual: an individual is required to supply verification in accordance with Chapter 5101:1-38 of the Administrative Code.

Replaces: 5101:1-38-04

Effective: 01/01/2006
R.C. 119.032 review dates: 01/01/2011
Promulgated Under: 111.15
Statutory Authority: 5111.01 , 5111.013
Rule Amplifies: 5111.01 , 5111.013
Prior Effective Dates: 5/1/1995, 7/1/2000